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Considerations for the Couples Match

Generally, because you are married or close enough. Any two people can enter the NRMP match as a couple, which will tie your residencies together by whatever rubric you choose. This is usually done in order to end up in the same geographic location, which can be defined as tightly (Manhattan) or as loosely (the Midwest) as suits your needs and circumstances:

On the whole, couples do relatively well in the match (91.6% of partners match together and at least one partner matched in 94.6% in 2012 according to the NRMP), barely different from that of singletons (95%). That said, your advisor will recommend that you increase the number of programs you apply and interview at accordingly. The more difficult the field you enter, the harder it is to couples match (per conventional wisdom). Double pediatrics is easier than pediatrics/radiology, which in turn is easier than radiology/dermatology.

The overall process itself is simple: you check an extra box on ERAS to inform programs and check another box (and pay an extra $15) for the NRMP to register, then submit your ROL (rank order list) together. You enter it exactly as you want it. If you want prestige over closeness for your dream program, you can do that (though your relationship might not survive it!)

Special Cases

There is no couples match for the early match specialties, although, if applicable, all preliminary years are part of the NRMP and eligible for the couples match. That means that if one or more partners is entering ophthalmology or urology, there is no way to guarantee being together during residency, end stop. There can be informal agreements and all sorts of hand-shaking, but no formal system will help you or preserve your sanity. Historically, ENT, neurosurgery, and pediatric neurology were also early match, but that is no longer the case.

All residencies requiring a preliminary year can also be tough. These include radiology, ophthalmology, radiation oncology, dermatology, as well as some neurology, rehab, and anesthesia. There are some programs in these fields that are categorical (meaning that they include the internship year), in which case you will match normally. But anyone entering an advanced field will couples match that advanced field with their partner’s program. The prelim year is not and cannot be part of the couples match itself (except for early match advanced fields). This means you cannot guarantee being in the same location for internship (but you can maximize your chances by attempting to go to locales or programs with large or multiple preliminary programs or be willing to enter a preliminary surgery year). If you want to ensure being together during intern year, then prepare for a large number of preliminary and transitional interviews and increased application/interview costs.

How to approach the process as a couple

It is advisable to let programs know you are couples matching. This can be done on ERAS directly. You can also touch on this in your personal statement if it flows. This encourages PDs in different specialties at the same institution to talk and can result in interviews for one applicant that they may not have otherwise received.

You will bring it up briefly during every interview (you’d be surprised how often programs can forget).

It is generally easier to focus on areas that have a sufficient number of options to make matching likely. This in part varies on which fields you will pursue, but larger cities like NYC, Chicago, Boston, etc. tend to work well for increasing the number of permutations. It’s also generally easy to get a larger number of interviews in your geographical region.

For couples with one partner in the Early Match, it is worth it to keep in contact with programs once the spouse knows where they have matched in order to stress that you are specifically vying for a particular area/program.

It is okay to politely inquire as to application status when one partner has received interviews from an institution but the other has not heard back, especially in areas with only one institution. Some fields send invitations significantly earlier than others. Most programs understand that one spouse will have little interest in attending an interview only to find out their significant other has been rejected. It’s a wasted interview from both sides of the table.

Always be polite, but don’t be too hesitant to contact when it will change your plans. If a program isn’t responsive or accommodating at this stage in a game, that’s something to keep in mind. I was surprised at how accommodating programs were when contacted, even very early in the season.

Most couples prefer to travel together when possible in order to explore new cities, save on travel costs, etc. The success for this is highly variable and depends largely on both programs’ schedules and the pushiness of applicants in attempting to ascertain interviews and reschedule when possible. Programs generally are sympathetic to the plight of the couple.

6 Comments

Great article. I am currently an MSIII and am considering couples matching next year. However, my area of interest is very competitive (direct plastics), and I fear that attempting to couples match will seriously hinder the possibility of both myself and my girlfriend to match. Overall, she is a moderately above average applicant with hopes of going into either emergency med or internal med. My question is whether you know of any alternatives to couples matching that may allow us to end up in the same place. One such possibility I have come across would be if we matched separately but she did a transition year, she could then apply to those programs nearest to me for the following year. I’m not sure if this would work, but any further advice would be greatly appreciated. Thanks!

This concern forms the basis of some pretty painful conversations between couples unsure about their priorities. Here are some thoughts:

1) Couples matching with one brutal field and one reasonable field usually results in the competitive field being the limiting factor (i.e. you are more likely to hinder her in the match than vice versa). If you make sure to apply broadly, there are likely a sufficient number of IM programs around that she would have little trouble finding a job compared to you.

2) The only true alternative is to coordinate your rank lists without formally tying yourselves together. This doesn’t really work all that well, for a variety of obvious reasons, and it certainly puts a serious strain on the relationship.

3) A transitional year would be a waste of a year for her. These one year programs only provide an internship for advanced specialties (rads, derm, etc). You typically can’t use it to skip the internship from a different field. Moreover, TY programs are relatively rare and some of the most competitive programs around. Categorical internal medicine or EM is a way safer option than getting any TY program (think about what fields are applying for those jobs).

4) In order for her to do prelim medicine first and then apply for a categorical job near you, it would require that there be an opening in the second year class for that program (or for her to repeat intern year). The former is by no means a sure thing and the latter would suck. She’d have better luck just trying to end up near you and trying to do a lateral switch if it doesn’t work out. I do know a handful of people who switched programs in IM and peds, for example. I’d argue it’s better to have a categorical slot and try to switch than a prelim.

Most people who choose direct plastics have a backup. If you have a backup (e.g. gen surg), then the odds of you both being separated or jobless will be quite low. That said, statistically, if she chooses IM, you are the limiting factor. If you apply to some large academic centers or busy cities, they’ll have big IM programs (and some big EM programs as well), and they’ll likely be able to coordinate. Many many programs are very sympathetic to couples and are happy when they can make things happen.

From personal experience, I was surprised at how accommodating the majority of programs were.

Great article, Ben. I would very much like to interview you for a couples matching article I am writing for AMBOSS, a medical learning platform dedicated to helping future physicians exceed on their exams and clerkships. Might you be interested in assisting me? I can tell you more over email :-)

this article put my mind at ease, well ease in the relative term going from 100mph toa respectable 80mph. Issue with my fiance and I is we are both applying for Peds and are scared we might be competing with each other (her step scores are better then mine) or that i might be dragging her down. Any thoughts ?

You guys aren’t really competing, any program will consider you a packaged deal. If anything, it seems the stronger candidate more often seems to drag the weaker one up than vice versa, though it partially depends on the degree of difference. Peds programs are generally big enough that you shouldn’t be concerned. It’d be one thing if you were both trying to compete for some integrated plastic surgery program with only two spots, but double peds is a nice common pairing.